Increase Revenue Growth by Capturing the Managed Medicaid Care Market

December 1st, 2016 - By Kristen Nehk

One of the largest opportunities for medical practice revenue growth in the next few years is the Managed Medicaid Care market. Nearly 93 million individuals will be eligible for Medicaid by 2024, and the vast majority of them are likely to enter managed care plans. Medicaid beneficiaries are a huge segment of the healthcare market that your practice may not be attracting, or attracting well.

Capturing this financially viable market requires a deep look at your workflow from the top down. Here, we go over the basics of Managed Medicaid, and steps toward approaching this segment of the healthcare market.

What is Managed Medicaid Care?

Managed Medicaid Care is a delivery system that provides Medicaid services, through managed care plans from managed care organizations (MCOs), to Medicaid beneficiaries. More than half of Medicaid beneficiaries receive a majority of their care from risk-based managed care organizations that contract with state Medicaid programs to deliver Medicaid services.  States pay MCOs a monthly premium (capitation) to cover the services provided by Medicaid to the beneficiary. Not all state Medicaid programs contract with MCOs, but most of them do and are rapidly expanding their use of MCOs. Expanding Medicaid services is a key component of the Affordable Care Act.

Steps towards Capturing the Managed Medicaid Care Market

Capturing the Managed Medicaid Market may require some significant changes to the way your clinic operates. As our friends at Trizetto Provider Solutions say, your success is dependent on a few key areas:

  • How you efficiently manage enrollment
  • Handle claims processing
  • Coordinate care
  • Control costs

Taking advantage of the growing Managed Medicaid market requires an investment in flexible and scalable IT systems that can adapt to change. The number one priority is core administration, network management, and care management systems that are integrated and allow automation in enrollment, eligibility, renewal, and in billing/collection. For example, an integrated quality electronic health record and practice management software system that has these features can achieve this goal.

Applications that can track analytics are also very important. You need to be able to narrow down and target key segments that may need intense care coordination, and provide them with the ability to compare the value and costs of clinical and incentive-based programs. Analytics enables you to be patient-first with your clinic.

Also, it is imperative to understand the value-based landscape we live in. Healthcare reform has changed the way we treat patients, from the Affordable Care Act to the Medicare Access and CHIP Reauthorization Act, incentivizing value and quality is starting to trump the volumetric payment system that dominated the market. However, patients may not understand how the climate has changed. Take action in incentivizing members to manage their own care through personalized wellness and support and educational programs may improve the health of your patients and control costs.

The Future of Medicaid in American Healthcare

American healthcare is an ever-evolving tornado of changes. Medicaid expansion is a hot item that is seemingly on the chopping block with the new presidential administration, but it is safe to say that Medicaid will not be repealed entirely, as it provides benefits to tens of millions of low-income Americans. We may see it change in nature; states may have more control over Medicaid than in the past, and the way it’s funded may change as well. Regardless of any changes, staying on top of Medicaid and the managed care plans through MCOs will enable you to capture the market.

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